Geriatrics Flashcards by amanda kastel

elderly patients are referred to greater than or equal to what age?

how can this be subdivided?

elderly = greater than or equal to 65

young-old (65-74)
old-old (75-84)
very old-old (85+)

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by 2030, 1 in _____ US residents is expected to be greater than 65

1 in 5

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what is the most rapidly growing age group in America?

adults 85 and older

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true or false

the number of persons age 65 and older is expected to decline in coming years

FALSE - increase

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what are the 5 “m’s” to remember for geriatric patients

Mobility
Mentation
Medication
What Matters
Multi-Complexity

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what is the most important healthcare technology in preventing illness, disability, and death in the geriatric population?

medication

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any symptom in an elderly patient should be considered what?

a drug side effect

(until proven otherwise)

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true or false

it is possible for hospital admissions to be drug related

true

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true or false

older adults are not at higher risk for adverse drug reactions as compared to young adults

FALSE - they’re 2-3 times at risk of an ADR

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true or false

adverse reactions are more likely in older adults, but the outcomes are not significant as compared to younger adults

FALSE

the outcomes ARE more significant in older adults

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true or false

medication related events is bad financially

true - costs around 528 billion a year and most occurs in older adults

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what is the problem to consider when comparing the expected medication effects between a young adult and an older adult?

the dose of a given medication produces a different and sometimes unexpected response in an older patient

even if the same gender and similar body weight

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true or false

if the gender and weight of a young person and old person are the same, their medication outcomes with the same dose of a drug given will likely be the same

FALSE

geriatric patients have a different and sometimes unexpected response

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what is the “explanation” to the problem that geriatric patients produces a different and sometimes unexpected response to the SAME DOSE of a medication as a younger person?

there are pharmacokinetic and/or pharmacodynamic alterations with age

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which explains the effect that a body has on a drug - pharmacokinetics or pharmacodynamics?

explain

pharmacokinetics

ADME

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what does pharmacodynamic mean

the effect that the drug produces in the body, usually through binding to receptors

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name 3 different types of absorption

gastrointestinal absorption
intramuscular absorption
transdermal (topical) absorption

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the effect of drug-protein binding changes with age.

this is under which category of pharmacokinetics?

distribution

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*which “piece” of pharmacokinetics is LEAST affected by aging

GI ABSORPTION

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explain why GI absorption is the least part of pharmacokinetics that is affected by aging

due to decreased gastric emptying, there may be a delayed onset of action. However, this is really only clinically significant for acute drugs such as tylenol

chronic drugs are not really affected by this

therefore, there is not a significant change in the QUANTITY of drug absorbed, there just may be a delay in the drugs peak time or onset time

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true or false

geriatric patients have increased GI motility

false - decreased GI motility, leading to prolonged absorption

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true or false

geriatrics have decreased gastric emptying rate

true - this is what can delay the onset/peak time of acute drugs

true or false

geriatrics have increased intestinal blood flow

false - decreased

true or false

geriatrics have decreased intestinal surface area

true

**in geriatrics, as mentioned, GI absorption seems to be the least affected by aging. which component of changes in GI absorption due to age is the MOST important? why?

decreased gastric acid output because we design drugs to dissolve in this acid. if there's not enough of it, the absorption of the drug may not be good

name a drug that doesnt need an acidic environment to absorb

calcium citrate

true or false elderly patients have decreased gastric pH

FALSE - increased

explain how IM absorption is affected by aging

possible decreased IM absorption because there is: -decreased muscle mass (hard to find spot) -decreased peripheral circulation (is the drug getting into blood) -increased connective tissue (is drug getting into blood?)

explain how topical (transdermal) absorption changes with age

there is a concern with both the drug penetrating the skin and also if the drug does penetrate, is it even getting into the bloodstream concern with no penetration due to decreased skin hydration and surface lipids, as well as increased keratinization concern with getting into blood due to decreased peripheral circulation thus, there is possible decreased absorption from transdermal patches with age

true or false geriatrics have increased surface lipids

false - decreased thus, penetration and thus absorption from transdermal patches may be affected

true or false elderly patients have increased keratinization of the skin

true - penetration of skin through transdermal patches is a concern

explain how distribution changes with age

mostly a concern for lipid soluble drugs elderly have increased body fat. thus, lipid soluble meds will be distributed to the fatty tissues. high Vd

true or false age-related changes in drug distribution are not really a concern for water soluble meds

true

true or false with age, there is a low Vd of water soluble medications

true high Vd for lipid soluble medications due to increased fat. this is a problem in relation to the distribution portion of ADME

elderly patients have ______ cardiac output how is this a concern?

decreased cardiac output this is a concern with the distribution of the drug. if a drug is being administered to relieve pain in the toes, there is a concern over whether the drug will even be DISTRIBUTED there due to decreased cardiac output compared to a young and healthy person

true or false elderly patients have increased body water

false - decreased

how does protein binding change with age and why is this a concern

there is DECREASED serum albumin this means that drugs that are highly protein bound like phenytoin and warfarin, will have an INCREASED free fraction in the bloodstream (because not bound to albumin) and thus more easily toxic

true or false geriatrics have decreased protein affinity

true

true or false geriatrics have increased alpha1-acid glycoprotein

true

name 2 highly protein bound medications

phenytoin warfarin

both metabolism and elimination of drugs are affected by age. which is more significant?

renal elimination

explain how drug metabolism is affected by age

there is decreased hepatic mass and bloodflow phase 1 reactions (oxidation/reduction/hydrolysis) are DECREASED phase 2 (conjugation) is UNCHANGED as well as CYP450 activity enzyme induction/inhibition is controversial

true or false drugs that are metabolized via phase 1 enzymes are preferred for geriatric patients

FALSE phase 1 metabolism activity is DECREASED with age drugs metabolized via phase 2 are preferred

true or false CYP450 activity is unchanged in elderly populations

true

true or false geriatrics have both decreased renal blood flow and decreased renal tubular secretion

TRUE

true or false geriatrics have increased GFR and thus decreased creatinine clearance

FALSE decreased GFR and thus decreased creatinine clearance

explain how estimating renal function may be more difficult in elderly patients

creatinine is made by muscle. elderly have decreased muscle mass and thus are making much less creatinine than a young person thus, it can be easy to look at blood levels and see low creatinine and think renal function is fine, but must remember that they are making much less to begin with

true or false elderly may have stable serum creatinine, even if kidney function is poor

true - due to increased muscle mass and thus making less creatinine to begin with

the average renal function of an 80 year old is ~____% of a 20 year ofd?

around 50%

older drugs used creatinine clearance as a measure to determine renal dosing newer drugs use what?

eGFR (estimated glomerular filtration rate)

what equation is used to estimate creatinine clearance?

Cockcroft-Gault equation

memorize formula?